title: Impact of graft-versus-host disease on allogeneic hematopoietic cell transplantation for adult T cell leukemia-lymphoma focusing on preconditioning regimens: nationwide retrospective study.
abstract: Allogeneic hematopoietic cell transplantation (HCT), but not autologous HCT, can provide long-term remission in some patients with adult T cell leukemia-lymphoma (ATL). We retrospectively analyzed the effects of acute graft-versus-host disease (GVHD) among the 616 patients with ATL who survived at least 30 days after allogeneic HCT with other than cord blood grafts. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated an association between grade I-II acute GVHD and favorable overall survival (OS) (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.477 to 0.843), whereas grade III-IV acute GVHD showed a trend toward unfavorable OS (HR, 1.380; 95% CI, 0.988 to 1.927) compared with nonacute GVHD. In subsequent multivariate analyses of patients who survived at least 100 days after HCT (n = 431), the presence of limited chronic GVHD showed a trend toward favorable OS (HR, 0.597; 95% CI, 0.354 to 1.007), and extensive chronic GVHD had a significant effect on OS (HR, 0.585; 95% CI, 0.389 to 0.880). There were no significant interactions between myeloablative conditioning or reduced-intensity conditioning with OS even when acute GVHD was absent or present at grade I-II or grade III-IV or when chronic GVHD was absent, limited, or extensive. This study demonstrates the actual existence of graft-versus-ATL effects in patients with ATL regardless of whether myeloablative conditioning or reduced-intensity conditioning is used.
authors.affiliation: Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: itakashi@med.nagoya-cu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Hishizawa
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Takatsuka
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hidaka
authors.forename: Naokuni
authors.initials: N
authors.lastname: Uike
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Tsudo
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Atae
authors.initials: A
authors.lastname: Utsunomiya
mesh_terms: D000208:Acute Disease; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000276:immunology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014182:Transplantation, Autologous
keywords: ATL-related mortality; HTLV-1; Mogamulizumab; TRM